Endocrine and Diabetes Medications

Thyroid Medications

• Medications for thyroid conditions:

  • Methimazole
  • Levothyroxine
  • Propylthiouracil (PTU)

• Methimazole and PTU: Used for hyperthyroidism.

• Levothyroxine: Used for hypothyroidism.

  • It is a synthetic thyroid hormone, unlike Armor Thyroid, which is derived from animals (horses) and has an unpleasant odor.
  • Adverse effects of levothyroxine resemble hyperthyroidism if the dose is too high (palpitations, heat intolerance, energy, weight loss).
  • Dosage adjustment usually resolves side effects.
  • Typically requires chronic therapy.

• PTU vs. Methimazole: PTU is safe to use during pregnancy, while methimazole is not. Both increase the risk of infection due to decreasing the immune system

• Levothyroxine: Synthetic thyroid hormone; the primary (and often only) treatment option for hypothyroidism

Growth-Related Medications

• Octreotide: Treats tumors that secrete growth hormone by slowing down growth.
• Somatotropin: Stimulates cell growth, used when growth is needed.

Desmopressin

• Used for its antidiuretic effect.
  • Side effect: hyponatremia (low sodium levels), which can be corrected by reducing the dose.
  • Used in diabetes insipidus, where patients lose too much fluid through excessive urination.
  • Important: Diabetes insipidus is different from diabetes mellitus, despite sharing the word "diabetes."

Steroids

• Fludrocortisone and Hydrocortisone: Steroids with similar side effects to prednisone.
  • Side effects: hyperglycemia (mainly with fludrocortisone), hypertension, osteoporosis, hypokalemia, insomnia.
  • Used to treat Addison's disease.

Diabetes Mellitus

Type 1 Diabetes

• Characterized by absolute failure of the pancreas, leading to an absolute insulin deficiency.
• Considered an autoimmune disorder.
• Treatment: Only insulin can be used.

Types of Insulin

• Rapid-Acting Insulin: e.g., insulin lispro.

  • Dosed about 15 minutes before a meal to cover the anticipated carbohydrate load.

• Short-Acting Insulin: e.g., insulin regular

  • Takes about 30 minutes to start working.
  • Commonly used as sliding scale insulin in hospitals.

• Long-Acting Insulin: e.g., insulin glargine, insulin detemir.

  • Used as basal insulin, typically taken at night, to cover background glucose needs.
  • Does not have a peak.

• Typical Insulin Regimen for Type 1 Diabetes:

  • Basal insulin (long-acting) to cover background glucose needs.
  • Bolus doses of rapid or short-acting insulin to cover glucose from meals.

• Insulin Pumps:

  • Provide real-time blood sugar information and can deliver insulin as needed.
  • Hemoglobin A1C (HbA1c): Measures average blood sugar over the past three months.
    • Target is around 7% or less.
    • Pumps help maintain lower HbA1c levels, reducing the risk of long-term complications (eye and kidney damage).

Hypoglycemia and Hyperglycemia

• Hypoglycemia: Irritability, hunger, sweating, loss of consciousness.

• Hyperglycemia: Increased thirst, blurry vision, increased urination (polyuria, polydipsia).

• Treatment of Hypoglycemia:

  • Always err on the side of giving glucose.
  • Glucagon pen or nasal spray for patients who can't swallow.
  • If able to swallow, give 15 grams of fast-acting glucose (glucose tablets, lifesavers).
  • Avoid foods with fat and protein (e.g., chocolate) initially, as they slow glucose absorption.

Type 2 Diabetes

• Characterized by insulin resistance, where the body does not effectively use the insulin it produces.

• Oral Medications:

  • Aim to decrease insulin resistance or stimulate the pancreas to release more insulin.

• Sulfonylureas (Glyburide, Glipizide) and Repaglinide:

  • Stimulate the pancreas to release insulin regardless of glucose levels, which carries a risk of hypoglycemia.
  • Can cause hypoglycemia because insulin release is not dependent on glucose levels.

• Metformin:

  • Does not cause hypoglycemia alone; reduces insulin resistance and decreases glucose production by the liver.
  • Common side effects: nausea and diarrhea.
  • Rare but serious side effect: lactic acidosis, monitored by kidney function (serum creatinine levels).

• Canagliflozin:

  • Picks up glucose and excretes it through urine.
  • Increased risk of bacterial cystitis (UTI) due to high glucose levels in the urine.
  • Prevention: drink enough water and urinate regularly.

• Acarbose:

  • Prevents glucose reabsorption in the GI tract, leading to bloating and gas.
  • Less commonly used due to GI side effects and the availability of newer, better-tolerated drugs.